Blog#219-10/17/24
THE YEARLY MEDICARE BLITZ
By Richard Davis
It’s that time of year when seniors are assaulted with all kinds of media ads for Medicare Advantage enrollment.
It is also the open enrollment period for Medicare, from October 15-December 7, when Medicare enrollees can change plans. Choosing a plan is always complicated but, if you gather good information, you can make an informed decision.
Less than half of seniors are enrolled in traditional Medicare. This plan has predictable costs and when coupled with a Medicare Supplemental policy will provide 100% coverage for hospital and outpatient care. Medicare coverage is comprehensive and traditional Medicare allows you to go to any health care provider in the country who is a Medicare provider. Almost all providers accept Medicare.
If you have traditional Medicare and you collect Social Security then a monthly premium for Part B, outpatient care, is taken out of your check. For most people that was $174.50 in 2024 and that will rise by 5.9% in 2025 to $185. Medicare Part A, hospital care, enrollment is automatic and there is no cost. But having Parts A and B only covers 80% of most care and that is why you need a supplemental policy to cover the remaining 20%.
It can be tricky finding a supplemental policy because private companies mimic Medicare in the battle for eyes on web sites. Here is the address for Medicare information about supplemental policies: https://www.medicare.gov/medigap-supplemental-insurance-plans/#/m/?year=2025&lang=en
Each state offers different options but all plan benefits have to be the same. The only thing that varies is the cost and the service. You can also go to a local insurance agent and ask them to help you find a policy so you can make sense of everything.
If you have traditional Medicare and a supplemental plan it will cost you $2220 a year in Part B premiums and about $200 a month, or $2400 a year, for a supplemental policy. Part A has a deductible of $1632 so the most you would pay in any year, depending on how much of the deductible you use, would be $6252 for excellent portable coverage. No gatekeepers, and you can see any specialist as long as they take Medicare.
Then there is Medicare Advantage (MA). It was created to move Medicare into the private sector and because more than half of Medicare eligible people now opt for MA plans it is accomplishing its goal. That means that in a short time it is possible that the Medicare program will be solely a private insurance entity.
MA lures people in by often not charging for premiums and also paying for a supplemental plan. They make their money when you enroll because the government pays them well just to have you sign up. MA is a great plan if you don’t get sick. It is also a good fit for people who like to gamble with their health and their money.
Remember the days of managed care when people complained about gatekeepers and restricted care? That is the hallmark of MA plans. They often deny care in life threatening circumstances, such as cancer care, and they make you jump through a lot of hoops just to get care that would be covered in traditional Medicare. MA is not portable because the companies that administer it require you to only see providers in their network.
The MA horror stories are starting to emerge. In addition to forcing you to fight for timely care, these plans also all have different limits on how much care they will pay for and how much it will cost you to use that care. Most plans will cost you $6000-$12,000 for care in a calendar year, but the amount will never be known until after you receive the care. MA enrolees are just adding to the misery of Americans who end up in debt because of medical bills. More than half of all U.S. debt is because of medical bills that insured and uninsured people can’t afford to pay.
These are some facts. If you want reliable information you can call a local Social Security office, an insurance agency or a local Council on Aging. Be careful when you go to web sites and make sure they are labelled medicare.gov.
